Physiotherapy in hemiplegia

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hemiplegia and physiotherapyWith an ever increase in the lifestyle disorders, the stroke is becoming more common problem. This can be attributed to increased cases of Diabetes, higher levels of cholesterol, increasing day- to- day stresses and thus hypertension. The most common type of stroke involves the infarction (death of tissues) of one part of brain which further results in inability to utilize the corresponding part of the body supplied by that.

Hemiplegia

It is one of the results of stroke, in which one side of body is unable to work properly due to weakness of that half. Generally, if left side of the brain is involved the right side of the body is weak ad vise versa.

Recovery factors in Hemiplegia

The amplitude of the weakness or inability to use the arm and the leg depends upon many factors:

Hand dominance

If the side that is dominant got affected, then it is much more difficult for a person to do the fine motor activities using that hand.

Size and site of lesion

If the size of lesion in the brain is larger then it will leads to weakness in the larger areas of the body. But the factor that matters the most is the sit of the lesion. If that site of the brain got affected that contains dense grey mater then the damage will, obviously, be more. This will leads to a larger disability e.g. involvement of internal capsule.

Age

The more will be the age, lesser will be the chances of complete recovery.

Delay in Treatment

At PhysioPort, we believe in the concept of therapeutic window for the patient of Hemiplegia following stroke. Therapeutic window is the frame of time in which maximum recovery can take place. Thus, there is no scope for delay in patients of Hemiplegia and physiotherapy should be started from the first day itself.

Stages of recovery in Hemiplegia

Stage 1: Stage of Flaccidity

Following stroke, the one side of the body is completely or partially paralyzed. There is no movement at all in the involved side. Generally, the patient starts recovering from the first day, from this stage. But there is marked variation in the period of this stage.  It may vary from first day to first month following stroke. Nursing care is foremost important, in terms of rehabilitation, when the affected side is completely paralyzed.

Stage 2: Stage of Spasticity

In Hemiplegia patient, once the flaccid stage is over, certain muscles starts becoming stiffer due to the increased in velocity dependent resistance or tone. This means that the local tone of the muscle is dominating over the central inhibition from the brain. This leads to inability of the patient to move the part under complete voluntary control. Although, he has certain movements that ca be use functionally. This voluntary control over the involuntary movements depends upon the repeated training. Thus, physiotherapy in Hemiplegia plays a very important role especially in the stage of spasticity. The physiotherapy treatment in Hemiplegia helps in decreasing the time frame of Stage of Spasticity.

Stage 3: Stage of Recovery

Slowly, the patient is able to perform movements out of involuntary movement patterns (synergies) and starts recovering. There is gain in functional movements and the coordinated movements become stronger. The good execution of latest techniques with strong basis of neurological rehabilitation is required for this. The well- established rehabilitation and physiotherapy goals at this stage of Hemiplegia results in better functional outcomes. This results in decreasing the overall time of recovery.

Physiotherapy in hemiplegia : Therapeutic window

Therapeutic window for each stage of Hemiplegia from the physiotherapy and rehabilitation point of view is as follows:

Stage of flaccidity

First month is the most crucial period following stroke, as this is the phase which will lay the foundation for stronger and better recovery in the coming period. The main goal in this phase should be

  • the prevention of any complication due to bed rest e.g. respiratory complications, pressure sores, DVT(deep vein thrombosis)
  • The facilitation of different movement patterns which will help in regaining the tone of the muscles.

Stage of spasticity

The therapeutic window for this stage varies with the factors such as age, compliance to the overall physiotherapy treatment and other psychosocial factors. But most of the movement patterns should start functioning in a voluntary pattern within 3- 6 months following stroke. Focus of rehabilitation I to avoid contractures, superimposing secondary and voluntary movement patterns over the primitive reflexes and synergies. This requires great deal of knowledge of neurosciences and neuro- rehabilitation on the part of physiotherapist, and similar amount of effort on the part of patient, to achieve optimal level of recovery.

Stage of recovery

Therapeutic window for this stage is between 6 months to a year. This stage should see the maximum level of functional rehabilitation. The focus is on learning the functional activities, activity and environment modification, if required, and lots of repetition so that the movement education is holistic and global.

Summary

Hemiplegia is a condition arising as a result of infarction in brain tissue. The outcomes and recovery of Hemiplegia depends upon the age, size of infarct and the hand dominance of the patient. Physiotherapy in Hemiplegia should be the mainstay of treatment and started as early as possible, so that the best recovery can be achieved during the optimum time frame.

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